Caption: A global study finds that unequal access to roads, power, and communication networks reduces life expectancy more than hospital access—just a 10% gap can cut a year off.
Credit: Tsinghua University
The infrastructure gap undermining global health
From roads to electricity, unequal access to economic infrastructure may reduce life expectancy more than a lack of hospitals or green space, say researchers.
Roads, power grids and communication networks are recognized as key drivers of a country’s wealth, vital for trade and production. A surprise discovery from a comprehensive study of 166 countries shows that this type of infrastructure has a more profound impact on life expectancy than hospitals.
“We found that a 10% increase in inequality in access to economic infrastructure is associated with a one-year drop in life expectancy,” says Bing Xu of Tsinghua’s Department of Earth System Science, who led the study published in Nature Human Behaviour1.
The finding, which used techniques to fill in data that are often missing from low-income countries, is among a slew of studies from the same team investigating the role of infrastructure in situations as diverse as the global response to the climate crisis and the spread of infectious diseases2.
Strong influence
In global health debates, economic infrastructure, such as transport, electricity, and telecommunications, is often treated as a backdrop, secondary to more immediate concerns like hospital access, clean water, or disease control. But Xu and her colleagues found instead that economic infrastructure had a stronger overall influence (see ‘The impact of infrastructure on life expectancy’) on health than social and environmental infrastructure.
“It may be that economic infrastructure provides the baseline stability needed for other systems to function,” says Xu.
The study also found that countries in lower-income nations in Africa, Latin America, Asia, and Oceania have only 50–80% of the access to infrastructure of their global north counterparts. At the same time, they experience up to 44% higher inequality in that access (see ‘Infrastructure differences —north and south’).
“Infrastructure inequality is not just a technical issue — it’s a public health issue,” Xu adds. International organizations such as the World Health Organization and United Nations must start treating infrastructure equity as a health imperative, not just a development goal, she argues.
Caption: Lower-income nations in Africa, Latin America, Asia, and Oceania have just 50–80% of the infrastructure access of global north countries—and face up to 44% higher inequality in that access.
Credit: Tsinghua University
Global mindset
Xu’s team had to first map infrastructure access and inequality of access across 166 countries. They then linked those patterns to health-adjusted life expectancy (HALE), the average number of years a person can expect to live in full health.
One of the biggest challenges facing the team was developing ways to correct for gaps in the data available for low-income countries. “In many parts of Africa, for example, there’s almost no reliable infrastructure data,” explains Ying Tu, a researcher who worked on the study during her PhD at Tsinghua, and is now a postdoctoral fellow at Cornell University in Ithaca, United States.
Tu’s expertise in remote sensing and geographic information systems (GIS) was key to the solution. She and Xu’s team helped build a global infrastructure dataset by combining satellite imagery — specifically night-time light data3, which helps capture human activity — with a crowdsourced database of critical infrastructure.
“We used the US as a benchmark to calibrate the relationship between light intensity and infrastructure presence, then applied that model globally,” says Tu. The importance of filling those knowledge gaps goes beyond the current study, say the researchers, as achieving many of the United Nation’s Sustainable Development Goals (SDGs) depends on having a complete picture of infrastructure accessibility and inequality.
The infrastructure dataset was classified as economic (roads and electricity), social (schools and hospitals), or environmental (green spaces and water systems).
The project was both technically ambitious and — for Tu — personally meaningful. “I’ve always been drawn to big, complex systems,” she says. “But this one felt especially important because it connects infrastructure to something as fundamental as life expectancy.”
The results confirmed in numbers what many development experts have long known: infrastructure access is not only lower in the global south, but also more unevenly distributed. “People in these countries face a double disadvantage,” Xu says. “They have less infrastructure overall, and what exists is often concentrated in wealthier or urban areas.”
She notes that addressing that imbalance is challenging. Typically, nations that today have good infrastructure “followed a path of rapid economic growth, serious pollution, and then cleanup,” Xu points out. “That model is not replicable today, especially given the environmental costs.”
Caption: The study, on the link between human health and infrastructure, was featured on the cover of Nature Human Behaviour in August 2025.
Credit: Nature Human Behaviour/Ref 1
Friendly flooding
Xu’s team is now studying the role of infrastructure in the spread of infectious diseases. “Traditionally, infectious diseases were more common in rural areas, while urban areas faced chronic diseases,” Xu explains. “But with rapid urbanization pushing into rural zones4, we’re seeing a new area of crossover, what we call the wildland–urban interface, where infectious and chronic diseases often overlap.”
To address these emerging challenges, the team is integrating climate adaptation and mitigation strategies into infrastructure planning for resilient development. “Our work explores how the cooling effects of green vegetation vary in extreme heat. In particular, we examine how vertical contrasts between trees and buildings modulate urban surface temperatures5, thus reducing heat-related mortality risk,” says Xu.
Caption: Bing Xu is a professor in the Department of Earth System Science at Tsinghua. She led a global study linking infrastructure inequality to reduced life expectancy, and is now urging global health bodies to prioritize infrastructure equity.
Credit: Tsinghua University
Meanwhile, at Cornell, Tu is working on another follow-up study that will examine how infrastructure access interacts with other climate hazards. “Imagine a region in Africa with mild weather but poor infrastructure, and a region like Arizona with extreme heat but strong infrastructure,” she says. “Which one supports better health outcomes? That’s what we want to explore.”
Tu is also exploring how infrastructure needs will change with climate change. In one project, she is exploring the feasibility of rice farming in upstate New York — a region historically unsuited to the crop, but now prone to rice-friendly flooding.
“It’s about adapting to new environmental realities,” she says. “And planning future infrastructure plays a huge role in that.”
Caption: Ying Tu is now a postdoctoral fellow at Cornell University in the United States. She completed her PhD at Tsinghua, during which she used remote sensing to map global infrastructure gaps.
Credit: Tsinghua University
For Tu, each study is a reminder that infrastructure is not just about physical systems — it’s about people. “When we talk about infrastructure, we’re really talking about accessing opportunities,” she says.
Her advice to early-career researchers looking to do large-scale research is to stay curious, stay resilient. “You never know where your research will take you,” she says. “But if you’re asking the right questions, it will matter.”
References
1. Tu, Y., Chen, B., Liao, C., Wu, S., An, J. et al. Inequality in infrastructure access and its association with health disparities Nature Human Behaviour 9, 1669–1682 (2025).
2. Wu X., Y. Lu, S. Zhou, L. Chen & B. Xu. Impact of Climate Change on Human Infectious Diseases: Empirical Evidence and Human Adaptation Environment International 86, 14–23 (2016).
3. Zhang, L., Ren, Z., Chen, B., Gong, P., Xu, B. & Fu, H. A Prolonged Artificial Nighttime-light Dataset of China (1984-2020) Scientific Data 11, 414 (2024).
4. Tu, Y., Wu, S., Chen, B., Weng, Q., Bai, Y. et al. A 30 m annual cropland dataset of China from 1986 to 2021 Earth System Science Data 16, 2297–2316 (2024).
5. Wei, H., Chen, B., Yin, Y., Wu, S., Zhang, T. & Xu, B. Vertical contrast of trees and buildings determines urban land surface temperature Landscape and Urban Planning 263, 105448 (2025).
